BANGALORE, KARNATAKA

SYNOPSIS FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

DISSERTATION PROPOSAL

A STUDY TO ASSESS THE EFFECTIVENESS OF

STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE
REGARDING NOSOCOMIAL INFECTION AMONG STAFF
NURSES OF BAPUJI HOSPITAL, DAVANGERE

Submitted By:
Mr,. BHAVANI SINGH
M.Sc., (Nursing), 1st year

BAPUJI COLLEGE OF NURSING, DAVANGERE

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 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
BANGALORE, KARNATAKA
ANNEXURE – II
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1 NAME OF THE CANDIDATE Mr. BHAWANI SINGH
AND ADDRESS (IN BLOCK 1st YEAR M.Sc., NURSING
LETTERS BAPUJI COLLEGE OF NURSING
DAVANGERE
2 NAME OF THE INSTITUTION BAPUJI COLLEGE OF NURSING
DAVANGERE – 577 004, KARNATAKA

3 COURSE OF STUDY AND 1ST YEAR, M.Sc., NURSING

SUBJECT MEDICAL SURGICAL NURSING

4 DATE OF ADMISSION TO 15th MAY 2007

COURSE

5 TITLE OF THE TOPIC “EFFECTIVENESS OF STRUCUTRED

TEACHING PROGRAMME ON
KNOWLEDGE REGARDING
NOSOCOMIAL INFECTION AMONG
STAFF NURSES OF BAPUJI HOSPITAL,
DAVANGERE”

6 BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

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 Good health depends in a part on a safe environment. Clients in all health
settings are at risk for acquiring infections because of lower resistance to infectious
micro-organisms, increased exposure to numbers and types of disease causing micro-
organisms and invasive procedures.1
Nosocomial infection result from delivery of health services in a health care
facility.1
Nosocomial infections are infections which are a result of treatment in a hospital
or a health care service unit, but secondary to the patient’s original condition. Infections
are considered nosocomial if they first appear 48 hours or more after hospital admission
or within 30 days after discharge.2
Most of the causative organisms are present in the external environment of the
patient and are introduced into the body through direct contact or through contaminated
materials.3
In the United States, it has been estimated that as many as o e hospital patient in
ten acquires a nosocomial infection or 2 million patients a year. Estimates of the annual
cost range from $4.5 billion to $11 billion and up.2
In many instances nosocomial infections could be prevented by strict aseptic
technique and by a reduction in the use of invasive procedures and antibiotics.3

6.1 NEED FOR THE STUDY:

Nosocomial infections have received increasing attention in recent years and are
believed to involve about 2 million clients per year. The most common settings
where nosocomial infections develop are hospital surgical or medical intensive care
units. Reports from the National Nosocomial Infection Surveillance System have
revealed that the urinary tract, the respiratory tract, blood stream and wounds are the
most common nosocomial infection sites.4
Nosocomial infections are most commonly transmitted by direct contact between
health personnel and patient or from patient to patient.5
In order to decrease the occurrence or continuation of nosocomial infections,
many agencies have an infection control department that investigates and sets up
policies to develop sanitary procedures. The nurse is responsible for providing the

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 patient with a clean and safe environment. The conscientiousness and accuracy of
the nurse in performing clean and aseptic procedures increases the effectiveness of
infection control.
Reported occurrence of nosocomial infections in United States range from 3% to
15.5% of hospital discharges, depending on the type of hospital, type of patients. On
the average, 5% to 7% of people who are admitted to general hospital acquire a
nosocomial infection.7
Nosocomial infections contributed to 88,000 deaths in the United States in 1995.
One third of nosocomial infections are considered preventable. Ms. Magazine
reports that as many as 90% of the deaths from hospital infections could be
prevented.2
A study was conducted by P. Mathur A. Kapil and B. Das on nosocomial
bacteraemia, intensive care unit patients of a tertiary care centre. The study was
conducted from July to December, 2001 in the ICUs of a tertiary care centre in
Northern India. The records of all the patients who had one or more episodes of
nosocomial bacteraemia during the study period were reviewed to identify the
pathogens causing bacteraemia and their antimicrobial sensitivities. A total of 152
episodes of nosocomial bacteraemia occurred in 140 patients. A high prevalence of
antimicrobial resistance in isolates causing bacteraemia in these critical care wards
warrants implementation of strict antibiotic prescribing policies and hospital
infection control guidelines.
A recent study showed how serious nosocomial pneumonia is the researchers
examined threetypes of nosocomial infection; pneumonia, infected surgical wounds
and UTIs of the patients who died because of their infections, more than 79% had
nosocomial pneumonia.9
This initiated the researcher to assess the effectiveness of structured teaching
programme on knowledge regarding nosocomial infections among staff nurses of
Bapuji Hospital, Davangere.

6.2 REVIEW OF LITERATURE:

The purpose for review of literature is to obtain comprehensive knowledge base

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and in depth of information from previous studies.
a) Pitt-Gomez C, Molina-Quilis R, Ruiz-Bremon A, depedro-Cuesta J (1995)
A descriptive study of nursing practices in nosocomial infection control in
Spain was conducted. During the period 1990-1991, a questionnaire, adapted
from that used in the study on the efficacy of nosocomial infection control was
mailed to all Spanish General Hospitals, public and private, having more than
400 beds, and to all those in the public health sector having more than 100 beds.
Nursing related information was selected for analysis from each of three sections;
staff, surveillance system and programmes. The response rate was 70%. Most
procedures proving nosocomial infection control efficient had been implemented
in 70-80% of responding hospitals. Teaching was most qualified and intensive in
medium sized hospitals.10

b) Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S,

Perneger TV (2000)
A study was conducted on effectiveness of hospital wide programme to
improve compliance with hand hygiene, infection control programme. The
overall compliance with hand hygiene during routine patient care in a teaching
hospital in Geneva, Switzerland, before and during implementation of hand-
hygiene campaign was monitored. Seven hospital-wide observational surveys
were done twice yearly. Secondary outcome measures were nosocomial
infection rates. More than 20,000 opportunities for hand hygiene were observed.
Compliance improved progressively from 48% to 66%. Hand hygiene improved
significantly among nurses and nursing assistants, but remained for among
doctors. During the same period, overall nosocomial infection decreased.11

c) Benoit Misset, Jean-Fruncois Timsit et al (2004)

A prospective single center study in the medical-surgical ICU of a tertiary
care center was conducted to assess the impact of continuous quality
improvement programme on nosocomial infection rates. 1764 patients were
admitted during the 5 year study period, 55% were mechanically ventilated and
21% died. Interventions implementation of an infection control program based on

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 international recommendations. The program was updated regularly according to
infection and colonization rates and reports in the literature.12
In a 5 years following implementation of the infection control programme
there was a significant decline in the rate of nosocomial infections.

d) Rabin Saba, Dilara Iran et al (2005)

A prospective observational study was conducted to assess the hand
hygiene compliance in a hematology unit. Two observers monitored the hand
hygiene compliance of health care workers in a hematology unit during 30
minutes observation periods distributed randomly during the day time over 2
months. The non compliance was higher among nurses. The lowest compliance
rate (4%) was observed before patient care and the highest (60%) was after
insertion of invasive devices. The study concluded that non compliance withhand
hygiene was high in this hematology unit, especially among nurses and before
activities. Variations with the type of health care worker and activity suggest that
targeted educational programs and feed back control may be useful.13

e) Christianes G, Barbier et al (2006)

A study was conducted to assess the effectiveness of hand hygiene
procedure for control of nosocomial infection as first measure. The hand hygiene
promotion programme started on May 2004 at the university hospital of Liege
after a baseline survey of compliance. An attempt was made to promote hand
hygiene and most particularly alcohol based hand disinfection. They measured
MRSA transmission rates and consumption of alcohol based hand rub solution
and soap in parallel. During the campaign, consumption of alcohol based hand
rub solution and soap increased by 56% and 24% respectively and MRSA
transmission rates decreased from 1,104 to 707 cases per 1000 admissions.14

f) Suchitra JB, Lakshmi Devi N (2006)

A study was conducted to assess the impact of education on knowledge,
attitudes and practices among various categories of health care workers on
nosocomial infections. A total of 150 health care workers, doctors (n=50), nurses

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 (n=50) and ward aides (n=50) were included. A questionnaire was administered.
A scoring system was devised (KAP score). They were further subjected to a
series of similar questionnaires at different intervals after an education module.
Statistical analysis was done using statistical software. Total compliance was
63% and ward aides were most compliant 76.7%. The study concluded that
education has a positive impact on retention of knowledge, attitudes and
practices in all the categories of staff. There is a need to develop a system of
continuous education for all categories of staff in order to reduce the nosocomial
infections.15

g) Soh KL, Koziol-Mclain J, Wilson J, Soh KG (2007)

A study was conducted on knowledge regarding prevention of nosocomial
pneumonia among nurses. A survey design using a mailed self-administered
questionnaire. 134 critical care nurses were identified through the nursing
council of New Zealand. The nosocomial pneumonia knowledge sore ranged
from 21% to 92%. The mean was 48%. No nurse demographic or workplace
characteristics was associated with nosocomial pneumonia knowledge. The study
concluded that several important deficits in nosocomial pneumonia knowledge
were identified indicating a need for critical care nurses to have greater exposure
to nosocomial pneumonia prevention education, guidelines and research.16

STATEMENT OF PROBLEM:
“A study to assess the effectiveness of structured teaching program on knowledge
regarding nosocomial infection among staff nurses of Bapuji Hospital, Davangere.

6.3 OBJECTIVE OF THE STUDY:

1) To assess the knowledge of nosocomial infection among staff nurses
2) To prepare and introduce structure teaching programme on nosocomial infection
among staff nurses.
3) To assess the effectiveness of structured teaching programme on nosocomial
infection through knowledge score.

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 4) To find the difference between pre-test and post-test knowledge score.
5) To determine the association between pre-test knowledge score and selected
demographic variables.

6.4 OPERATIONAL DEFINITION:

1) ASSESS: It is organized systemic and continuous process of collecting data from
hypertensive clients with history of hypertension.
2) EFFECTIVENESS: In this study effectiveness” means “improving the
knowledge regarding nosocomial infectionamong staff nurse by planned health
teaching which may result difference between pre and post test score.
3) STRUCTURED TEACHING PROGRAME: It refers to systematically planned
teaching program designed to provide information regarding nosocomial
infection among staff nurses.
4) KNOWLEDGE: It refers to correct response of the staff nurses to knowledge
items on nosocomial infection achieved by knowledge score.
5) NOSOCOMIAL INFECTION: It refers to those infections which develop after
the patient has been admitted to the hospital.
6) STAFF NURSES: Staff nurses are those who have completed general nursing or
B.Sc nursing as per the Indian Nursing Council regulation.

6.5 HYPOTHESIS:
The mean post test scores of subject exposed to structured teaching programme
will be greater than their mean pre test scores as measured by structured
questionnaire at 0.05 level of significance.

6.6 ASSUMPTIONS:
1) Staff nurses may not have complete knowledge regarding nosocomial infection.
2) Structured teaching programme will significantly increase the knowledge level of
staff nurses.

6.7 DELIMITATIONS:

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 1) The study is limited to staff nurses of Bapuji Hospital.

6.8 PROJECTED OUTCOME:

The staff nurses will have enhancement in knowledge regarding nosocomial
infection.

7. MATERIALS AND METHOD

7.1 SOURCE OF DATA COLLECTION: The data will be collected from staff nurses
at Bapuji Hospital, Davangere
RESEARCH DESIGN: One group pre and post test experimental design
SETTING: The study will be conducted in Bapuji Hospital, Davangere
POPULATION: In this study population consist of staff nurses who fulfill the
required criteria and who are working in Bapuji Hospital at the time of the study.
SAMPLE SIZE: The total study sample consists of 50 study nurses who are
working in Bapuji Hospital.

INCLUSION CRITERIA FOR SAMPLING:

1) Both male and female staff nurses are included.
2) Staff nurses in the age group of 21-58 years of age will be included.
3) Those who are willing to participate in the study.

EXCLUSIVE CRITERIA:
1) Staff nurses who are not willing to participate in the study.

7.2 METHOD OF COLLECTION OF DATA

SAMPLING TECHNIQUE: Purposive sampling
INSTRUMENT:
Section A: Socio demographic data
Section B: Structured questionnaire will be prepared to assess the knowledge of staff
nurses regarding nosocomial infection.

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 VARIABLES:
Independent variable: Structured teaching programme
Dependent variants: Knowledge regarding nosocomial infection among staff nurses.

DATA COLLECTION METHOD:

Step 1: Intvestigator in produces himself to staff nurses.
Step 2: Administration of pretest by giving questionnaire on knowledge items.
Step 3: Administration of structured teaching programme regarding nosocomial
infection.
Step 4: Administration of post test on knowledge of nosocomial infection.

PLAN FOR DATA ANALYSIS:

The data will be analyzed by using appropriate statistical method and the finding
will be presented in the form of figures and tables.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR

INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER
HUMANS OR ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY.
Yes, structured teaching programme will be administered to staff nurses of
Bapuji Hospital.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION IN CASE OF 7.3?
Yes, written permission will be obtained from institution as well as from hospital.
8. LIST OF REFERENCE
1) Potter-Perry. “Fundamentals of Nursing”. 6th edition, Elsevier Publications,
Missouri, 2005, pp 773, 729.
2) www.google.com
3) Phipps, Long, Woods. “Shafer’s Medical-Surgical nursing”. 7 th edition, B.I.
Publications, New Delhi, 1996, pp 164.

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4) Barbara Kozier, Glenora Erb, Andrey Berman, Karen Burke. “Fundamentals of
Nursing”. 7th edition, Pearson Education Publishers, Singapore, pp 669.
5) Basavantappa B.T. “Fundamentals of Nursing”. 1 st edition, Jaypee Brothers
Publishers, New Delhi, pp 140.
6) Grace Cole. “Basic Nursing Skills and Concepts”. Mosby Year Book
Publishers, Missouri, pp 2040
7) Deanna E. Grimes. “Infectious Diseases”. Mosby Year Book Publishers,
Missouri, pp 275-280.
8) Mathur P, Kapil A and Das B. “Nosocomial bacteraemia in intensive care unit
patients of tertiary care centre”. Indian J Med Res 122, October 2005, pp 305-308.
9) Carol Calianno. “Nosocomial Pneumonia”. Nursing 96 May, pp 34-39.
10) Pliff-Gomez C, Molina-Quilis R, Ruiz-Bremon A, dePedro-Cuesta J. “Nursing
in nosocomial infection control in Spain”. J Adv Nurs 1995 March; 21 (3): 440-6.
11) Pittet D,Hugonnet S, Harbarth S et al. “Effectiveness of hospital-wide
programme to improve compliance with hand hygiene. Infection Control
programme. Lancet, 2000 Oct 14; 356 (9238): 1307-12.
12) Benoit Misset, Jean-Francois Timsit et al. “A continuous quality improvement
program reduces nosocomial infection rates in the ICU”. Intensive care medicine,
Springer Berlin Publishers, March 2004; 30 (3): pp 395-400.
13) Rabin Saba, Dilara Iran et al. “Hand hygiene compliance in a hematology
Unit”. Acta Haematologica 2005; 113: 190-193 (DOI: 10.1159/000084449).
14) Christiaens G, Barbier C et al. “Hand hygiene: first measure to control
nosocomial infection”. Rev Med Liege 2006 Jan; 61 (1): 31-61.

15) Suchitra JB, Lakshmi Devi N. “Impact of education on knowledge, attitudes

and practices among various categories of health care workers on nosocomial
infections”. J Adv Nurs 2006 Mar; 24 (4): 110-6.
16) Soh KL, Koziol-Mclain J, Wilson J, Soh KG. “Critical care nurses knowledge
in preventing nosocomial pneumonia”. Aust J Adv Nurs 2007 Mar-May; 24 (3):
19-25.

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9. Signature of the Candidate

10. Remarks of the Guide

11. 11.1 Name & Designation of Guide

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 11.1Signature

11.2Co-Guide (If any)

11.3Signature

11.4Head of the Department

11.5Signature
12 12.1 Remarks of the Principal

12.2 Signature

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